Introduction

In May 2018, the House of Commons Standing Committee on Health released its report: ‘Pharmacare Now: Prescription Medicine Coverage for All Canadians’. This report details the current state of pharmacare in Canada and culminates in a list of 18 recommendations on how to develop a single-payer, universal pharmacare program. This means that one public plan would provide free prescription medication to Canadians.

The Current State of Pharmacare in Canada

Many Canadians currently have their prescription medication covered by a patchwork of private and public plans. Private plans are often obtained through benefits packages offered by employers while public coverage is provided through provincial programs such as the Ontario Drug Benefit (ODB) Program, which provides coverage for individuals who are over the age of 65. These private and public plans vary across Canada and are associated with high premiums, deductibles and/or co-payments that are fees that must be paid before you can receive your medication.

Then there are individuals who fall through the gaps of this patchwork. Many people who are self-employed or work part-time do not have access to private drug coverage and do not qualify for public coverage. These individuals are left with no option but to pay for medications out of pocket. Research shows that having to pay so little as two dollars for a medication can limit someone’s access to life saving drugs.[1] It is estimated that more than one in five Canadians do not take the prescription medications they require because of their high costs.[2]

Why We Need Universal Pharmacare

Having a universal pharmacare program would mean that all Canadians would have equal and efficient access to the medications they need.

Some argue that rather than moving to a single payer system we should try to fill in the gaps for those who lack coverage. Québec currently follows this model by having mandatory prescription insurance and relying on private plans to fill in the gaps. To cut costs, private companies often favour healthy individuals and charge those with pre-existing health issues high fees meaning that even if they can find coverage they likely will not be able to afford it.[3] A single payer program would eliminate the burden of having to seek out drug coverage and allow all Canadians to access medication at the time that they need it.

Access to pharmacare is a social determinant of health. When your ability to access medication is dictated by your financial situation or existing health conditions it creates major inequities across populations. This is currently the case in Canada. These inequities have a detrimental impact on peoples’ ability to work, care for the their families and contribute to society.

Doctors report that when people cannot afford their medication they either take less in an effort to make it last longer or they do not take it at all.[4] This results in an increased number of individuals ending up in the hospital or even dying as a result of health conditions that could easily be prevented or kept under control by taking their medication as prescribed by their doctor.

Hospital care is expensive and represents a significant and disproportionate part of dollars invested in health care. Our hospitals are also overcrowded. Providing individuals with needed medication will prevent unnecessary, costly hospitalization.

Not being able to afford lifesaving drugs impacts mental health as well. Many people are forced to choose between buying medications that are required for their own or a family member’s well-being and putting food on the table. This results in people not being able to function at their best and also leads to feelings of embarrassment and shame. Doctors have reported that some patients in this situation will put off going to the doctor knowing their condition is not under control because they have not been taking their medication causing issues to worsen over time.[5] Not being able to afford medication can result in anxiety and fear that over a long period of time can cause individuals to struggle with their mental health and require even more unaffordable medication to cope with the symptoms they are experiencing. And the cycle continues…

Pharmacare: Essential to a Just and Fair Society

Canadians pay some of the highest prices for prescription pharmaceuticals per capita in the world.[6] One way that countries such as New Zealand have brought down the cost of drugs is by buying from drug companies in bulk and by having a national body negotiate the price.[7] If Canada moved to a single payer universal pharmacare program, we would be positioned through our buying power, to bring down the cost of pharmaceuticals.

A common argument is that private insurance companies and the government already buy in bulk, yet medications remain costly. They ask what difference can a single payer plan make? In New Zealand, the cost of a year’s supply of Lipitor, a common cholesterol drug, is just $15 while in Canada it costs $811.[8] Clearly, the evidence indicates that we could be doing more to bring down the costs of medication.

Decreasing the number of hospital visits, working to bring down the cost of pharmaceuticals through bulk purchasing and cost negotiations and streamlining the system with a single payer program will not only improve the well-being of people but also will create significant savings which can then be put towards currently underfunded areas in our social and health systems.

Steps Forward

A report by the Parliamentary Budget Officer (PBO), “estimates total drug spending under a national Pharmacare program would amount to $20.4 billion, if implemented in 2015-2016.”[9] From 2015-2016 expenditures, “this represents savings of roughly $4.2 billion.” [10]

Besides moving to a single payer plan and buying in bulk, the House of Commons Standing Committee on Health has also recommended:

consider the establishment of a real time reporting system so doctors have more up to date information on the medications their patients are taking, and[12]

assemble a shared national ‘formulary’, which is the list of medications approved for coverage, for all provinces and territories.[13]

1. Prescribing Practices

Doctors currently receive anywhere from 9-50 hours of training in clinical pharmacology in medical school.[14] There are over 13,000 drugs on the market in Canada. As our population ages, a growing number of seniors suffering from chronic health conditions, take 10 or more medications at once.[15] Doctors do not receive the appropriate training to navigate this complex situation.[16]

A common fear amongst those who are against universal pharmacare is that if there is easy access to drugs people will over use medication. Part of ensuring this does not happen would be to improve doctor training in clinical pharmacology.[17] Dr. Cindy Forbes also recommends that having real time access to a record of the medications a patient is taking would contribute to better and more informed prescribing practices.[18]

2. Inefficiencies

There is room to improve the relationship between physicians and pharmacists.[19] Throughout their four years of professional school, pharmacists receive extensive training in clinical pharmacology and toxicology providing them with valuable knowledge of all drugs on the market and their interactions in the body. Improving the relationship between physicians and pharmacists creates more opportunity for collaboration. Pharmacists could work together with doctors to assemble care plans for patients with complex medication needs.

Pharmacists are also easily accessible to the community and can provide valuable and immediate information on prescription or over the counter medications, which can help to equalize some of the burden that usually falls on doctors as a result of the general public not fully understanding the role of a pharmacist.

Currently, pharmacists in Ontario can do Medschecks, which are one on one meetings with a patient to discuss all medications they are currently taking. The results of this meeting are then sent to the doctor to keep them updated. In theory this system makes sense, however there are many extenuating circumstances that prevent Medschecks from occurring as efficiently as they are intended.

According the Ontario Pharmacist’s Association, a Medscheck should take around 20-30 minutes.[20] However, many pharmacists work alone without the help of an assistant, something that is dictated by the head office of the large corporations that house community pharmacies, meaning they often do not have the required time to spend doing multiple Medschecks per day. Possible improvements to this system maybe a designated pharmacist working on Medschecks while another pharmacist tends to the flow of patients. Medscheck opens lines of communication between pharmacists and physicians to allow for valuable up-to-date medical information to be shared with all members of a patient’s circle of care.[21]

3. Inequities

The formulary[22] currently varies for each of the provinces and territories. This creates inequities amongst Canadians as someone living in Alberta may be able to access medication which is not covered in Ontario. We also need to assess what drugs are currently on the formulary. A common myth is that newer medications are better medications. In reality newer medications are often very similar to medications already on the market but cost more. Also, new medications can cause unknown side effects. When a medication has been on the market for a number of years, we know what the long-term effects are.

In the Standing Committee’s report, Dr. Cara Tannenbaum reminds us of the gender impact in pharmaceuticals. In establishing a shared formulary, we need to be conscious of the fact that women often require different medications or different dosages than men, which can impact the cost of medications. In establishing a shared national formulary, a sufficient number of hormone related contraceptives need to be included.[23]

Who is left out?

Although universal pharmacare is the logical next step in improving Canada’s health care system, it is important to acknowledge that some will continue to experience barriers to accessing medications. If the pharmacare program follows the current system modeled in hospitals, individuals will require a health card to access services. Individuals living in Canada who may be undocumented or who are unable to obtain a health card for extenuating reasons such as homelessness, mental health or mobility issues will continue to face barriers in accessing their medications.

Implications for Private Insurance Providers

If Canada moves to a single-payer, universal pharmacare program, drug coverage from private insurance companies will likely be eliminated. The Standing Committee’s report indicates we need a better understanding of how this will impact job loss in industry and whether these jobs can be transferred to whatever entity would manage such a program.[24]

Conclusion

From both an ethical and a financial standpoint, universal pharmacare is an important pillar of Canada’s and Ontario’s safety net. Universal pharmacare must be a joint policy and program initiative between the federal and the provincial/territorial governments.

As the cost of pharmaceuticals continues to rise the limitations of our current system, both its inefficiency and unsustainability, become clear. Implementing universal pharmacare will create a more effective, equitable system with fewer barriers to access life saving medications. This improves the health and well-being of Canadians.

Often community members such as the Boyne Britannia Neighbourhood Group are pushed to ask important questions: Why? What and who will benefit? Will harm be done to the people, community and to the environment? Civic society is dependent on evidence, education, dialogue and, ultimately decisions that inform action essential to build a safe community where human well-being is a priority. I bring the concerns and effort of these Milton citizens to your attention.

Joey EdwardhExecutive Director

BackgroundThe Canadian National Railway Company (CN)

CN Rail is a multi-national corporation with revenues of $250 billion in 2018. Over the last 25 years, it has purchased 1,200 acres of land on the southwest corner of Milton and they are now proposing 400 acres be used to build its Rail Hub. The facility would be approximately 2,900 metres in length and have the capacity to handle four trains per day. Once completed, the terminal would operate 24 hours a day, seven days a week. It would be bordered by Tremaine Road to the west, Britannia Road to the north, Lower Base Line to the south and Highway 25 to the east.

The proposed CN Rail Hub or transport interchange will enable cargo to be exchanged between intermodal vehicles: that is rail cars and transport trucks. This intermodal exchange has the advantage that it can be done without any handling of the freight itself when changing modes. The method reduces cargo handling, and so improves security, reduces damage and loss, and allows freight to be transported faster. Reduced costs over road trucking is the key benefit for inter-continental use. In 2008, CN announced that the economy could not support their proposed Rail Hub and they would not proceed with its construction. In 2015, CN reversed its decision and announced it planned to build the Rail Hub in Milton.

Milton and Halton Region Planning

A decade ago there were 54,000 people living in Milton. Now, it’s about 113,000, with a 30.5 percent population growth between 2011 and 2016. The average age of Milton residents is 35, making it the youngest community in Ontario. Census figures show about 30 per cent of the population is 19 or younger.

Milton is experiencing an array of development challenges since the town began growing. Schools are struggling to house the population. GO transit has yet to be able to accommodate all the commuters to downtown Toronto. Fees to developers do not cover the health and emergency services the town and region must provide. Milton planners have their sights set at population growth to 400,000 in 30 to 40 years.

In 2013, Halton Region and Milton approved a regional plan that assumed the CN Rail Hub would not be built. The plan includes high intensity residential (20,000 new homes), recreation, commercial and education facilities development immediately beside the proposed CN Rail Hub.

Access Road Issues with the Proposed CN Rail Hub

Milton community groups and individuals have claimed that building the CN Rail Hub now will affect quality of life of the growing population of Milton. Negative impact of the Rail Hub includes:

Property devaluation by the unsuspecting home owners who have purchased the newly built homes adjacent to the proposed CN Rail Hub.

The 24 hour a day 1,600 trucks and the 130 Rail Hub employees will create long rows of waiting trucks, heavy road use not only near the CN Rail Hub but throughout Milton as the trucks from the CN Rail Hub leave the Rail Hub directly into residential neighbourhoods built following the most recent Milton and Halton Region plans.

The CN Rail Hub will be handling toxic materials that will create risk to the adjacent residents.

Employment density will be far below the Provincial mandate – 5,000 versus 15,000– CN feels it is not required to meet density targets.

Development fees not collected to support infrastructure costs.

Loss of property taxes for Milton and Halton Region.

Regional Road #25 is the main road the 1,600 trucks a day will use travelling to and from the Rail Hub as it is presently the only road linking Milton to the 407 and the Queen Elizabeth Way.

In May 2018, truck routes for the CN Rail Hub are not built including the widening of Britannia Road, although the CN Rail Hub would be located on Tremaine Road, this road is not presently connected north to the 401 or south to the 407. Without one of these roads, truck traffic on Milton’s already busy arterial roads will be excessive.

Even though the southern part of the Rail Hub could be connected south on Regional Road 22, the CN Rail Hub is presently designed to have traffic only enter on the north side with all 1,600 trucks 24 hours a day entering a residential area of Milton.

Detailed information about the proposed CN Rail Hub is available on the Halton Region website (http://www.halton.ca/CN). As well, more issues are raised by the “Milton Says NO” community group (www.miltonsaysno.com).

CN Rail Research on Impact of Proposed Milton CN Rail Hub

In 2017, Scott Streiner, CEO of the Canadian Transportation Agency, reported in a speech to the Railway Association of Canada that a different approach was being taken by his agency for the approval process for construction of the proposed CN Rail Hub. He stated:

“We haven't had a large number of rail construction applications in recent years, but when they do come in, they can be contentious, depending on the planned location of the new line. A case in point is CN's proposed Milton logistics hub, for which the Minister of Environment and Climate Change and I have agreed to a joint hearings process – a sort of single window for gathering information relevant both to the environmental assessment and the Agency's determination on whether or not to authorize construction.” (https://otc-cta.gc.ca/eng/content/chair-and-ceo-scott-streiner-addresses-railway-association-canada-may-11-2017)

Therefore, the Milton Logistics Hub Project Review Panel (see ceaa.gc.ca Ref #80100) is a joint process established under the Canadian Environmental Assessment Act, 2012, and the Canada Transportation Act.

CN had submitted a report to the Panel in January 2018 (https://www.ceaa-acee.gc.ca/050/documents/p80100/121598E.pdf) about its ‘public consultation’. This report claimed shopping mall customers and interest groups favoured the proposed CN Rail Hub. This is in contrast to what a public referendum may find, for example, if a referendum had been included as part of the November 2018 municipal election. However, the deadline for submitting a referendum question was March 1, 2018.

In addition, CN’s ‘Mitigated Day-Night Sound Level Contours – Operations” study also submitted to the Panel in January 2018, omits the noise impact of the 1,600 Rail Hub trucks a day on Milton streets.

It’s Never Been More Important for Big Companies to Listen to Local Communities

The Harvard Business Review (November 2017) (https://hbr.org/2017/11/its-never-been-more-important-for-big-companies-to-listen-to-local-communities) reported that there are new tools for governing the relationship between large corporations like CN with local communities. These include community benefit agreements, memoranda of understanding, and multi-stakeholder agreements designed to document commitments, responsibilities, and benefits surrounding a large investment project such as the CN Rail Hub. It is pointed out that these tools can help bring clarity to all involved and must be reviewed and renegotiated over time.

In March 2018, two community meetings were convened by CN to discuss the offering of ‘gifts’ to community groups to secure their support for the Rail Hub. Examples presented at these meetings and reported in CN’s “Milton Logistics Hub – Benefits Brief” involved:

Transportation and transit

Evaluate development of dedicated truck lane from proposed facility to 407

Contribution to additional overpass in the Halton Region in partnership with all levels of government

Recreation

Contribution to partnership for a new arena in Milton

New connections to regional cycling network

Additional pedestrian/cycling overpass over mainline

Contribution of land to provincial greenbelt

Investment in a community park

Contribution to a new community sports field

Education and environment

Contribution to higher education programs or facility to Halton Region

New contributions to community programs and partnerships

Contribution to program or capital for Milton Education Village/Innovation Centre

However, in the same “Benefits Brief”, CN states it would support these and other ideas as long as:

The proposed Project is approved with reasonable, acceptable conditions

CN would be a contributor to a partnership funding envelop, not the sole contributor

The benefit does not require additional environmental assessment scope related to the proposed Project.

The proposed Project is not contingent on this additional benefit

The benefit does not impact the proposed Project’s schedule

The benefit is feasible

There is no specific timeline associated with the benefit

CN is not responsible for the operation or the maintenance of the benefit

Memoranda of understanding, and multi-stakeholder agreements designed to document commitments, responsibilities, and benefits surrounding the CN Rail Hub have yet to be agreed upon. These presumably would include negotiating with CN to relax the above listed conditions CN has stated in supporting any ‘benefits’.

Since 2014, the Halton Municipalities have cooperated in assessing the CN Rail Hub proposal for potential effects relating to areas of provincial and municipal responsibility through the Federal Environmental Assessment process.

Court Challenge

In March 2018, the Region of Halton, the Town of Milton, the City of Burlington, the Town of Halton Hills, and the Town of Oakville and Conservation Halton have filed a joint Court application to confirm their jurisdiction to review the impacts of the CN Rail Hub. This is in response to CN’s assertion that the CN Rail Hub is an exclusive federal jurisdiction, and neither the Province nor the municipalities have any regulatory role with respect to it.

Conclusions

The proposed CN Rail Hub highlights community issues that urgently need to be acted on by all stakeholders:

Milton should conduct a referendum outside of the election which would be much more representative of community views than Milton shopping mall ‘surveys’ conducted by CN’s consulting firm.

Milton and the Region of Halton should seek the support of local residents as part of the Court challenge so that local governments and citizens have an input into the decisions that affect their lives.

A process to disseminate information and create opportunity for broad public discussion of and consensus on the implications of the proposed CN Rail Hub. This is required to ensure a balanced approach to this proposal that is in the best interest of all concerned.

The impact of the truck traffic impact on Milton requires further examination including consideration of the proposed CN Rail Hub being redesigned so that its main entrance is not Britannia Road on its north side, but to Regional Road #22 on its south side.

More discussion about how local neighbourhoods in Milton receive from CN benefit agreements, memoranda of understanding, and multi-stakeholder agreements designed to document commitments, responsibilities, and benefits.

Community Development Halton as a member organization of the Social Planning Network of Ontario (SPNO) supports the following policy and budgetary recommendations made at an Ontario Pre-Budget consultation on January 29, 2018. I share these with you as these recommended changes in policy will enhance the well-being of Ontario and Halton residents. They represent additional steps in building a healthy civic society.

Joey EdwardhExecutive Director

Introduction

SPNO acknowledges the important social investments that the Government has made in the last eighteen months in areas such as prescription drug coverage for children and youth, post-secondary tuition relief for low income families, increased support to seniors, expanded child care spaces, and, most recently, passage of The Fair Wages, Better Workplaces Act.

Policy and Budget Considerations

There, of course, remain important areas for policy and budget consideration in 2018-19.

While increasing the minimum wage was a major accomplishment in the last year and is generally recognized as just and fair in the public mind, the Government has recognized the increased cost pressures on about 400,000 small businesses and has accommodated with a business tax reduction. The 55,000 nonprofits and charities in Ontario with minimum wage employees are eager to pay their workers fairly. Unfortunately, raising prices in service work to their communities is not an option for most. As the Ontario Nonprofit Network has requested with the support of its organizational members including SPNO, the wage cost increases should be reflected in adjustments to Transfer Payment Agreements for the last part of 2017-18 and in new agreements for the next fiscal year.

SPNO has been an active contributor to the Ontario Government’s Community Hubs initiative to improve community capacity for health, social, economic, and cultural supports. We support the Ontario Nonprofit Network’s recommendation for capital funding, low cost loans, and multi-year, multi-program funding agreements for community hubs.

Through local research and a project on student well-being involving 14 communities, the SPNO is concerned about inequities and exclusion in the school system. A specific concern requiring attention in the 2018 Budget is the pressure on local school boards to use Learning Opportunities Grants designated for support to students in low income communities for other purposes. This problem arises from an inadequate school funding formula that SPNO recommends that the next Budget begin to address.

SPNO appreciates that both the provincial and federal governments are assuming more leadership on the affordable housing agenda, although much of the actual investment at least federally is spread over a long-time frame. Legislated inclusionary zoning would initiate more immediate relief. Inclusionary zoning assures that affordable housing is built to promote socio-economically diverse neighbourhoods. It requires developers to include a set portion of below-market units, either to buy or to sell, in every residential building. Unfortunately, the regulations as now drafted are counterproductive to the intent and purpose of inclusionary zoning. Although this enabling legislation for municipalities would not seem to have a direct impact on the Ontario budget, inclusionary zoning that requires additional direct costs on municipalities will undermine local adoption, thus reducing the role of municipalities as effective partners with the province and the federal government in solving the affordable housing crisis.

Finally, SPNO urges action on the recently released report, Income Security: A Roadmap for Change. As a long-term plan the report’s recommendations would transform the culture of the social assistance system from a policing and punitive model to a more personalized, responsive and supportive approach for Ontario’s most vulnerable residents. The proposal of achieving a Minimum Income Standard for all living in deep poverty is critically important, but A Roadmap for Change sets an unacceptably long-time horizon for achieving this standard (10 years). The specific recommendations for increases amounting to about 22% by 2020 for a single adult would still leave single recipients just over half-way to the official income poverty line. Notably, the Lankin and Sheikh Social Assistance Review Commission Report in 2012 recommended that the Government implement a $100/month Healthy Food Supplement endorsed by 25 municipal councils across the province, which would have been a 17% income increase for adults on social assistance in the first year.

As long as Government revenues reflect an Ontario economy that is showing strong growth, a first-year commitment in 2018-2019 to a larger rate increase in the order of 15% to 17% in the 2018 provincial budget would show a serious Government commitment to addressing deep poverty. SPNO recommends this first step for the 2018-19 budget and an accelerated plan for achieving the Minimum Income Standard within three to five years.

A new report, Income Security: A Roadmap for Change, recommends comprehensive changes to Ontario’s income security programs, Ontario Works, and the Ontario Disability Support Program. Many of you receiving this Community Dispatch work with people who are recipients of these two programs and are witness to their struggle to meet the necessities of life: food, shelter, transportation, health, and social services. I believe that the release of this important report was lost in the coverage and debate on the new Labour legislation – Bill 148, Fair Workplaces, Better Jobs Act, 2017 with its accompanying move to a $15 minimum wage and the celebrations of the Holiday Season. Therefore, to contribute to community understanding and dialogue, I would like to share with you the commentary of Community Development Halton’s provincial association, the Social Planning Network of Ontario (SPNO), on A Roadmap for Change. It is an important report that recognizes the dignity and humanity of those participating in our income security programs.

Joey EdwardhExecutive Director

Introduction

The Social Planning Network of Ontario (SPNO) is pleased to respond to Income Security: A Roadmap for Change, the recently released report on income security reform in Ontario produced by three working groups set up by the Ministry in 2016. We appreciate the opportunity to offer feedback to this latest report.

In doing so, we do wish to express our agreement with the analysis and recommendations with respect to A Roadmap for Change expressed in the submission of the submission of the Income Security Advocacy Centre (ISAC), which we have studied and support.

Conceptual Framework for Change

Overall, we find A Roadmap for Change to be an impressive and comprehensive approach to income security reform in Ontario. It properly situates social assistance within the larger income security system. Its critique of the social assistance system as it is now structured and operates is consistent with the research findings of community-based organizations that have documented the failure in the income support system for more than 20 years.

The review establishes up front a strong set of principles for a future income security system including “rights”, “equity and fairness”, “dignity and respect”, and critically, in terms of making a material difference in the lives of Ontarians living in poverty, “adequacy”, a principle and objective for which SPNO has advocated along with many other community groups and organizations since the campaign for an Ontario Poverty Reduction Strategy in 2008.

A Roadmap for Change presents a conceptual framework on the future state of income security centred on the notion of creating social and economic inclusion for those who require public assistance with their daily living needs. The graphic representation on page 2 clearly reflects the inter-connected array of supports required to realize the vision of social and economic inclusion.

Although labeled as “Income Security: Future State”, this is really a more all-encompassing vision of individual and family well-being. Ironically, while the six components identified as creating inclusion are all essential, “income support” or “decent income for daily living” is not among them. This may not seem to be important. But conceptually, especially in terms of clarity in the public’s mind, income support (often seen as “welfare” in a narrow, negative sense) should be explicitly identified and integrally linked to the other forms of social, health, and employment supports for stability, security, opportunity, and participation in community life.

Seriously Addressing Deep Poverty

Since 2008, poverty reduction policy in Ontario has been about fighting child poverty. Although not as much as originally targeted, there has been some success in reducing child poverty, increased in the several years by action at the federal level. Commendably, A Roadmap for Change addresses the issue of poverty in general and is explicit about the need for action on people in deepest poverty, single working age adults. It proposes a Minimum Income Standard (income floor below which no one should fall), which at first uses the current official Ontario Poverty Rate (LIM-50) but may be modified as a result of research over the next few years on Market Basket Needs varying by region. This approach would be fairly consistent with the private member’s Bill 6, Ministry of Community and Social Services Amendment Act (Social Assistance Research Commission), 2016. Bill 6 proposes setting social assistance rates based on field level research on the real cost of living, has wide community support, and received all-party support through a second reading in the Ontario Legislative Assembly.

Proposing a Minimum Income Standard for all living in deep poverty is critically important, but A Roadmap for Change sets an unacceptably long-time horizon for achieving this standard (10 years). The specific recommendations for increases amounting to about 22% by 2020 for a single adult would still leave single recipients just over half-way to the official income poverty line ($10,700 for Ontario Works (OW) recipients). The recommended base rate OW increase in the first year is 10% and the recommended Ontario Disabilities Support Program (ODSP) increase from a higher base level is 5%. Notably, the Lankin and Sheikh Social Assistance Review Commission Report in 2012 recommended that the government implement a $100/month Healthy Food Supplement endorsed by 25 municipal councils across the province, which would have been a 17% income increase for adults on social assistance in the first year.

As long as government revenues reflect an Ontario economy that is showing strong growth, a first-year commitment to a larger rate increase in the order of 15% to 17% in the 2018 provincial budget would show a serious government commitment to addressing deep poverty. Further, combined with development of the proposed Ontario Housing Benefit, an accelerated rate increase program to achieve the Minimum Income Standard earlier than the recommended 10-year horizon is necessary to achieve social and economic inclusion and well-being.

Finally, with respect to the issue of adequacy in setting a basic social assistance rate, it may be advisable to refer to a “Decent Standard Rate” or, as in the Lankin and Sheikh Commission Report, a “Basic Measure of Adequacy”, rather than a “Minimum Income Standard”. The term “minimum” has become strongly associated with the statutory hourly minimum wage rate, especially with the policy discussion and community advocacy campaigning for the recently successful Bill 148, Fair Workplaces, Better Jobs Act, 2017. Since there will be a differential between the final adequate standard social assistance rate and the annual income generated from full-year, full-time earnings at a minimum wage level, confusion between the two in the public mind should be avoided.

Balanced Restructuring of Benefits

Research and community development work by SPNO members across the province concur with A Roadmap for Change with respect to identifying the cost of housing as a major barrier to stability and security in the lives of low income individuals and families. The portable, income-tested housing benefit available to both social assistance recipients and working poor is good and would certainly factor into achieving a Minimum Income Standard. Again, however, as with the rate increase recommendations, the housing benefit proposal starts small, covering the gap between an affordable rent and the actual cost at 25% in 2019-20, 35% in 2020-21 and rising to 75% by 2027-28; another long-time horizon to full implementation, which should be accelerated, especially since it seems there may be some complementary federal action on affordable housing.

How social assistance benefits should be structured can be a contentious issue in income security reform. The inclination in “simplifying” the system is to integrate or consolidate in a uniform way, which can ignore the importance of appropriate differentiation for particular conditions. A Roadmap for Change recognizes the need for balance in this respect. Integrating the two-part composition of OW and ODSP benefits (Basic Needs and Shelter Allowance) into one Standard Flat Rate (a little higher for persons with disabilities) has been recommended by community-based organizations and groups as an appropriate change to the benefit structure. Retaining ODSP as distinct from OW in social assistance, however, recognizes some of the particular income security issues of persons with disabilities – especially regarding their tenuous connection to the labour market. An “assured income” for persons with disabilities and easier transition in and out of employment without loss of income and benefits is another recommendation responsive to their particular support needs.

A Roadmap for Change is highly sensitive to the myriad of fragmented benefit and support programs to persons with disabilities. It argues for consolidation and integration of these various sources of income so that “stacking” them could approach an adequate “assured income”, but importantly, is also careful to avoid change to existing supplemental benefits without further study (e.g. special diet allowance, medical transportation assistance, and assistive devices). SPNO supports the recommendation to retain special benefits such as these for now while engaging people now receiving them, policy experts and community advocates in a “co-design process” to determine how they might be re-fashioned into the overall income security system. This is a respectful and deliberative approach to system reform.

Further, in making the argument for “stacking,” A Roadmap for Change does attempt to distinguish between living needs that should be met directly through income transfers and extraordinary community living costs that require supplementary service or income supports. See the Appendix for the recommendations that speak specifically to this point. (pp. 108-111, and pp.121-122).

This is a critically important distinction, since people in particular circumstances have living expenses beyond the regular daily costs of living (e.g. person with disability needing attendant care; low income individual living in a remote community with costly transportation to needed health services; single or low-income parents requiring help with childcare costs). In that regard, expanding core health benefits to all low-income persons and families, including those in deepest poverty, is probably one of the most important and commendable recommendations in A Roadmap for Change (pp. 86-87). These kinds of essential supplementary benefits and service supports should always be recognized as coverage distinct from income adequacy for normal everyday living costs and should never be “monetized” into the calculation for a Minimum Standard Rate. A clear and precise distinction of the income benefit and support service structure for a comprehensive approach to social and economic inclusion would reflect three main components:

income – adequate to meet the cost of daily living needs, including housing (Minimum Income Standard);

employment supports for the opportunity to participate in the labour market and become more self-sustaining; and

health and social supports – stabilizing factors such as drug coverage, counselling, mental health services, childcare, extraordinary daily living needs for persons with disabilities such as attendant care.

Transforming the Culture to Trust and Collaboration

The section in A Roadmap for Change on “Transforming Social Assistance” reflects the leadership of George Thomson who facilitated the review process. This section is an updated version of his landmark welfare reform report Transitions in the late 1980s. Transitions’ positive vision of “welfare reform” got lost in the economic and political conditions of the early and mid-1990s. In fact, this period not only resulted in the slashing of benefit rates, but it introduced the intrusive and punitive culture in the administration of social assistance that prevails to this day. Recognizing this as a major challenge, A Roadmap for Change calls for a “culture of trust, collaboration and problem-solving” and a “person-centred approach” to working with people on social assistance, converting social assistance workers from a policing and monitoring roles to “case collaborators” in helping people not only achieve stability in their lives but also develop opportunities to participate in the community (reminiscent of “Opportunity Planners” in Transitions). This transformation would not only have a major positive impact on the lives of people using the system but also on the sense of contribution and accomplishment of the workers who provide the services and supports. SPNO strongly supports this kind of cultural transformation in the design and delivery of income security in the province.

Conclusion

Finally, A Roadmap for Change devotes a good amount of time and attention to income security reform to First Nations communities, which have special self-governance and resource requirements and claims on the provision of support to Indigenous peoples in Ontario. SPNO respects and supports the recommendations in A Roadmap for Change made by the First Nations Income Security Reform Working Group and the Urban Indigenous Table on Income Security Reform.

Recommendation 10: Use an inclusive process to design an “assured income” approach for people with disabilities.

10.1

Co-design an “assured income” mechanism for delivering financial support to people who meet the ODSP definition of disability. Consultation with First Nations people is essential.

10.2

Include the following features in the assured income mechanism:

Income-tested only (i.e., no asset test).

Stacking of income benefits to reach adequacy.

Tax-based definition of income (i.e., does not include

financial help (gifts) from family or friends).

Continued responsibility of the provincial government to determine disability, with the right of appeal to the Ontario

Social Benefits Tribunal.

Flexibility to adjust to in-year income changes.

Safe to move into employment and back to the program.

10.3

Provide an initial Assured Income benefit at least as high as the ODSP Standard Flat Rate at the time of transition. Provide continued increases until the Minimum Income Standard is achieved in combination with other income security components (see Setting a Goal for Income Adequacy, page 69).

10.4

Ensure that people receiving the Assured Income have full access to ODSP caseworker services and support.

10.5

Provide First Nations with the ability to administer and deliver ODSP in their own communities in the same manner as Ontario Works.

Recommendation 13: Modernize income and asset rules so people can maximize the income sources available to them and save for the future.

13.1

Exempt as assets funds held in Tax-Free Savings Accounts and all forms of Registered Retirement Savings Plans so people do not have to deplete resources meant for their senior years.

13.2

Initially exempt 25% of Canada Pension Plan - Disability, Employment Insurance and Workplace Safety and Insurance Board payments from social assistance (i.e., social assistance would be reduced by 75 cents for every dollar of income from these sources rather than dollar for dollar).

13.3

Increase the income exemption for Canada Pension Plan ­ Disability, Employment Insurance and Workplace Safety and Insurance Board to the same level as the existing earnings exemption by 2022–23.

Recommendation 14: Ensure ongoing access to targeted allowances and benefits until such a time as adequacy is achieved. Determine which extraordinary costs remain beyond the means of individuals even when adequacy is achieved and maintain those benefits.

14.1

Retain the following special-purpose allowances/benefits and review as progress towards adequacy is made and people’s outcomes are better understood:

Special Diet Allowance

Mandatory Special Necessities/Medical Transportation.

Pregnancy and Breast-Feeding Nutritional Allowance 

ODSP Work-Related Benefit

14.2

Revise medical transportation rules to include and support improved access to traditional healers.

14.3

Review and introduce expanded eligibility criteria for the Remote Communities Allowance to better address the needs of northern and remote communities.

14.4

Redesign Ontario Works discretionary benefits as other recommendations are implemented (e.g., making core health benefits and help with funeral and burial costs mandatory) and consider making them available to the broader low-income population.